Elderberry

What elderberry is

Elderberry is the dark purple berry of the European or black elder tree, a plant whose botanical name is Sambucus nigra and which grows in Europe, North America, western Asia, and North Africa. The berry is sold in the United States as a dietary supplement. Like other supplements, these products are not reviewed by the FDA the way prescription medicines are, so what is actually in them can vary from one brand to the next.

This page is general education about elderberry as a supplement. It is not a recommendation that you should or should not use it; that is a conversation to have with your clinician about your own situation.

What it is used for

People usually take elderberry hoping to ease a cold or the flu, and that is close to what it has been studied for. Some early research suggests it may relieve the symptoms of flu, colds, or other upper respiratory infections, though this comes from only a small number of studies, and there is not enough information to say it helps with any other health problem.

One use is worth calling out directly: do not rely on elderberry for COVID-19. There is not enough evidence to know whether it helps, and the FDA and the Federal Trade Commission have taken action against companies that marketed elderberry products with unproven claims about COVID-19.

Because elderberry is used for colds and flu, not the mind, it is not a mental health treatment. The federal guidance does not study or support elderberry for mood, anxiety, depression, sleep, or thinking, so in a psychiatric setting it is not a treatment for any symptom. As with anything, whether it fits for you is case by case.

How it might work

The research on elderberry is preliminary, and the federal guidance does not establish how it might work. What little study there is has focused on the symptoms of colds, flu, and other upper respiratory infections, not on mental health. A product sounding natural or protective is not the same as it being proven to help, so it is fairer to treat any benefit as modest and uncertain.

How people take it

Elderberry is taken by mouth. The most important safety point is about preparation rather than amount: raw or unripe berries and the leaves and stems are toxic, and cooking eliminates that toxin. For that reason, you should never make your own elderberry preparation from raw berries or plant parts. If you are considering a product, the more useful step is to talk it through with your clinician rather than to chase a dose.

What to expect

If you try a prepared elderberry product for a cold or the flu, keep your expectations modest, since the evidence behind it is limited. Do not expect anything for mood, sleep, or focus, because it has not been studied or supported for those. And do not rely on it for COVID-19, for either prevention or treatment. As always, this is case by case.

Possible side effects

When elderberry is cooked, the federal guidance does not report specific side effects. The real harm comes from the raw plant. Raw or unripe elderberries, and the leaves and stems of the elder, contain poisonous cyanide-producing substances that can cause:

• Nausea
• Vomiting
• Severe diarrhea

Cooking eliminates this toxin, but large quantities of it can cause serious illness. If you or someone else swallows raw berries or plant parts and becomes ill, do not wait it out; use the help options at the bottom of this page, which include calling 911 for a medical emergency.

Interactions and safety

The federal guidance does not name specific medicines that interact with elderberry, but it is clear about the general caution: if you take any kind of medicine, talk with your clinician before using elderberry or other herbal products, because some herbs and medicines interact in harmful ways. A couple of other points round out the safety picture:

• The toxicity of the raw plant is the headline. Raw or unripe berries, leaves, and stems are poisonous, and cooking eliminates the toxin, so never use homemade preparations made from raw plant parts.
• Little is known about elderberry in pregnancy or while breastfeeding, so it is worth asking before using it then.

The simplest safeguard, as with any supplement, is to tell your clinician and pharmacist everything you take, including supplements and over-the-counter products, so we can catch a problem before it happens and decide together whether elderberry fits your plan.

When to contact your clinician

For routine questions, mild side effects, or whether elderberry fits with the rest of your plan, send a message through the patient portal or bring it to your next visit. These are part of your ongoing care and are answered in the normal course of a few business days, so they are best for things that are not urgent.

If something feels urgent, you do not need to wait for a reply. The fastest way to get care is 911 or the nearest emergency department for a medical emergency, a severe reaction, or signs of poisoning after swallowing raw berries or plant parts, or 988 any time for a mental health crisis or thoughts of self-harm.

Questions to ask your clinician

• Is a commercially prepared elderberry product safe alongside my medications?
• Is it safe to use if I am pregnant or breastfeeding?
• Is there any real benefit for me, or is this mostly for cold and flu symptoms?
• What should I avoid, such as raw berries or homemade preparations?
• If my real concern is mood, anxiety, or sleep, what should we actually be looking at?